Provider Demographics
NPI:1245548742
Name:YOUNG WOMEN'S EMPOWERMENT CENTER LONG TERM 3
Entity type:Organization
Organization Name:YOUNG WOMEN'S EMPOWERMENT CENTER LONG TERM 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LSAC
Authorized Official - Phone:435-283-0164
Mailing Address - Street 1:66 N.181 W.
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627
Mailing Address - Country:US
Mailing Address - Phone:435-283-0164
Mailing Address - Fax:435-283-2213
Practice Address - Street 1:66 N. 180 W.
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627
Practice Address - Country:US
Practice Address - Phone:435-283-0164
Practice Address - Fax:435-283-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16462320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness